Revenue Cycle TRANSFORMATION

Increase net revenue, manage costs, and enhance the patient experience

Health systems are losing tens of millions of dollars every year due to hazards along the revenue cycle pathway.  We can add millions of additional annual net revenue dollars to any hospital – on its same book of business – and measure that value within the implementation project period. 

Our holistic approach, along with our revenue cycle transformation solutions and methodologies, identifies, prioritizes, and addresses the tactical issues and weaknesses along your health system’s revenue stream. We’ll help you strengthen your business operations and protect the hard-earned dollars that should flow to your annual net revenue. With our decades of experience and expertise across healthcare operations and your EHR system, we’ll quickly help you identify the opportunities that will make a difference. We’ll then help implement the right changes to address root causes to improve efficiencies, reduce variation, increase net revenue, and maximize the positive experience for your patients, your staff, and your physicians.

We partner with you to

  • Reduce the avoidable losses across your organization
  • Position your organization for increased, sustainable annual net revenue improvements
  • Improve the usage of your EHR (and other systems, as applicable), including workflows, reporting, staffing models, and work allocation

Success Stories

revenue cycle

Comprehensive or targeted revenue cycle transformation

Comprehensive revenue transformation

Nordic can perform a broad revenue transformation project across a single hospital or across a large health system.  A broad project takes into account multiple facets to provide a holistic outcome, including consideration of systems (EHR plus any “bolt-ons”), processes, culture, change management, coaching and mentoring, structures, staffing models, reporting and metrics, and enhancing a positive patient experience.  These broad projects can add measurable value to your organization within a defined project time-period. They also provide foundational transformation structures for further future organizational success. It is not uncommon for these large transformational projects to add 2-6 percent additional annual net revenue for the organization. This can equate to several million dollars – which can be a game-changer for health systems.

Targeted focus areas

Our consultants ensure you're setting a foundation for success, following best practices, and setting up your organization for long-term success by proactively anticipating and managing potential risks.

PATIENT ACCESS STRATEGIES AND REFERRAL MANAGEMENT 

Patients enter the healthcare system through many avenues, and whether services are planned or unplanned, they’re always personal. Our approach to patient access prioritizes the patient experience by reducing the number of “touch points” for the patient, helping gather the right insurance information, providing more consistent and  simple collection of patient upfront payments, and proactively assisting those unable to pay. During this focused work, we can assist your organization with the following:

  • Measure and help reduce referral leakage
  • Estimate and help manage patient liability communication
  • Develop policies and procedures for financial clearance and financial assistance, including development of financial counseling tools to leverage assistance programs (some geographic areas have 50+ assistance programs available to their patients)
  • Align your resources to your organization’s needs through “staff-to-demand” analytics and centraling certain aspects of your organizational model, where applicable for your specific organization
  • Enhance referral coordination, communication, collaboration, and associated processes
  • Proactively manage operational KPIs through dashboards and reporting

SERVICE DOCUMENTATION AND CHARGE CAPTURE

Accurate charge capture is critical to maximizing reimbursement and improving revenue, but the complexities of the process make it susceptible to breakdowns. We take a holistic approach to your charge capture process, including deep data analytics across your organization, interviews with key stakeholders at the point of care, observing key processes, chart and account reviews, and system interfaces and system capability considerations. We review your organization’s charge master, analyze your revenue and usage statistics, conduct deep data analytics including multiple algorithmic and correlation comparisons, review third-party payor contracts, conduct claim reviews, and consider current state and federal regulations to identify areas of opportunity in your charging practices. Some of the focus areas include:

  • Identify revenue “black holes” in the charge capture process and reduce potential lost revenue
  • Validate that service prices are appropriate, defensible, and strategic based on comparative data
  • Provide structures and processes to support that new and existing services are documented and charged accurately for appropriate recognition of services performed
  • Update the CDM and other supporting dictionaries, as applicable
  • Implement workflows and reporting to monitor the charge entry and reconciliation process
  • Provide education and coaching at the point of care to augment clinical staff engagement and improved understanding of impact to the organization

CASE MANAGEMENT AND TRANSITION PLANNING

The goal of case management is to get the patient the right care, in the right setting, at the right time – and cost-effectively. Our comprehensive case management solution optimizes staffing and workflows along the entire continuum of care to drive optimal access, patient health, and use of resources. We focus on the following:

  • Ensure the right level of staffing via organizational model assessment and redesign and staff-to-demand analytics
  • Define and align roles and responsibilities more clearly in case management, utilization management, and social work
  • Standardize clinical denial and appeal processes
  • Improve discharge and transition planning with workflow improvements and staff training
  • Enhance post-acute care coordination, communication, collaboration, and processes
  • Provide management dashboard and metrics

DENIAL MANAGEMENT AND PAYOR COMMUNICATION

Even small losses driven by payor denials and administrative burdens can amount to millions of lost dollars for a health system, which ultimately means losses for the patient and the community. Here are some of the areas where we focus:

  • Identify losses and root cause issues
  • Develop tactical plans and help implement change
  • Provide staff-to-demand analytics and strategies
  • Define vendor strategy and usage
  • Support managed care strategies and negotiations
  • Strengthen patient liability management
  • Improve accuracy of bad debt processing
  • Enhance charity identification and recognition
  • Provide algorithms to measure actual results
  • Provide coaching and training
  • Develop executive and management dashboards and metrics

Full-cycle revenue solutions

Our Nordic revenue solutions include all aspects of the revenue cycle from point of entry to resolution and closure of account for each patient visit. Broad categories of focus are outlined below:

Access to care

  • Financial counseling
  • Patient cost estimates and financial clearance
  • POS collections
  • Provider scheduling
  • RTE and benefit automation
  • Referral coordination and management
  • Scheduling and service authorizations
  • Pre-service centers and consolidation of services

Care delivery

  • Case management
  • Charge capture and CDM management
  • Clinical documentation improvement
  • Coding/HIM
  • Discharge and transition planning
  • RVU reporting
  • Strategic pricing and utilization review
  • Managed care contracting and reimbursement models

Post-care

  • A/R strategy
  • Strategic vendor alignment and management
  • CFB Reduction
  • Avoidable write-offs
  • Threshold and approvals
  • Bad debt process improvement
  • Billing edit process management
  • Cash and adjustment posting
  • Charity recognition
  • Denial management
  • Self-pay management
  • Insurance follow-up

There are also other strategic and operational considerations such as:

  • SBO implementation and consolidation
  • Bolt-on vendor support and cost/benefit determination
  • Strategic vendor usage
  • Staffing models
  • Coaching and mentoring
  • Maximizing benefit through mergers and acquisitions
  • Selective and strategic automation
  • Improving both patient and physician experience and overall satisfaction

 

A holistic approach to revenue cycle enhancement

ASSESSThis is the foundation - based on data, not perception. We review your specific data and your specific situation to provide a relevant, strategic, and realistic approach and solution for your specific organization. 

DESIGN The right solution – considering process, technology, and people. Our focus is on issue resolution, incorporating the aspects of all major elements.

IMPLEMENT A relevant and appropriate strategic focus - providing current measurable benefit with long-term consideration. It’s not just the “project” we complete for you, but the foundation in how we position you for the longer term. 

The Nordic Difference

Expertise In healthcare, Epic, and all major EHR health systems
Data-driven Approach to measurably improving net revenue
Proven resultsDelivering what we say we will
Holistic approach Longer-term, sustainable results

Award-winning service

Nordic was the firm most recognized as a true partner in KLAS’ Healthcare Consulting and Services Report 2018.

In KLAS’s 2016 Optimization Services report, we had the highest number of organizations reporting significant positive impact, and Nordic scored 92.3 for Revenue Cycle Optimization. One client gave this feedback to KLAS: 

Nordic has created not just a partnership with our organization, but a real relationship. They were able to work with us to make our efforts sustainable. Our work with Nordic will be ongoing.

Multi-hospital system / Teaching health system

Nordic's work in both revenue capture and revenue cycle contributed to the $30M+ OIP we’ve gained.  Nordic was great to work with, finished on time, in budget, and exceeded financial outcomes.

VP OF REVENUE CYCLE, MULTI-HOSPITAL (MULTI-STATE) SYSTEM

I am amazed at how smooth everything has gone with our implementation and I know that it’s the way Nordic deals with people that makes a difference.


COO, TEACHING HEALTH SYSTEM

Let's unlock your revenue potential together.

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